PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

92 Acting early on NCDs The Partnership for Health System Sustainability and ResilienceFrance implemented a ’direct access’ pilot scheme (2023–25) allowing temporary reimbursement immediately following favourable HAS opinion for medicines with major therapeutic benefit, bridging the gap between regulatory approval and price negotiations. This approach recognises that price negotiations, whilst necessary for sustainability, should not delay access to transformative therapies. Early evidence suggests the scheme reduces access delays by 6–12 months for qualifying medicines. Germany’s early benefit assessment (AMNOG) process, whilst creating initial delays, provides structured pathways for innovative medicines with additional benefit. Medicines demonstrating superiority over existing treatments receive premium pricing, creating incentives for genuine innovation rather than marginal modifications. The transparent process provides predictability that encourages launch despite the assessment requirements. Digital health implementation Digital transformation of health systems offers unprecedented opportunities for improving NCD prevention and management, yet implementation reveals fundamental challenges in governance, interoperability, and equity. Electronic health record adoption Countries have achieved substantial progress in electronic medical record adoption, with Greece reporting 100% of primary care practices using EMR (OECD, 2023a) complemented by integrated patient mobile applications enabling access to health information. Spain achieved 99% primary care EHR adoption by 2021, demonstrating that comprehensive digitisation of clinical documentation is achievable even in diverse regional systems (OECD, 2023a). However, these impressive adoption statistics are often hampered by interoperability challenges that results in limited digital infrastructure and coordinated care. Despite claims of full EHR interoperability, only 8 of Spain’s 17 autonomous regions effectively share medical data (UOC, 2022). Italy faces similar fragmentation, with regional systems unable to exchange information between primary and secondary care providers, forcing patients to carry paper documents between providers despite universal EMR adoption. The absence of unique patient identifiers across regions means that the same patient may have multiple unlinked records, preventing comprehensive views of medical history. Canada exemplifies this interoperability challenge with 95% of physicians now using EMRs, yet only 1 in 3 sharing patient information electronically outside their practice (CIHI, 2024). Provincial access to EHRs also varies dramatically, ranging from 60% in Saskatchewan to just 14% in Manitoba and Newfoundland and Labrador (CIHI, 2024). Japan’s ambitious Medical DX Reiwa Vision 2030 outlines plans for nationwide healthcare information platforms, standardised EMRs across all institutions by 2030, and unified medical remuneration calculation programmes to reduce administrative burden (MHLW, 2023d). The vision recognises that technical standards alone are insufficient: success requires governance structures, change management, and alignment of incentives. Germany’s experience shows how progress in digital health implementation can stall. Gematik, established in 2005 to oversee national digital infrastructure, took 18 years to implement the electronic patient record (ePA), largely due to prolonged disputes among stakeholders over data governance, privacy, professional autonomy, and technical standards (BMG, 2019). In 2018, Germany ranked second to last among 17 countries in a Digital Health Index evaluation, reflecting the slow pace of digitalisation. After years of limited uptake under an opt-in approach, the nationwide rollout of the ePA in April 2025 adopted an opt-out model, with only about 5% of patients declining participation (AOK, 2025). This outcome suggests that while privacy concerns had often been cited as a barrier, structural and organisational challenges played a greater role in constraining adoption.